PDF herunterladen
CC BY-NC-ND 4.0 · AJP Rep 2020; 10(03): e213-e216
DOI: 10.1055/s-0040-1715165
Case Report

Impact of Excess Weight Gain on Risk of Postpartum Infection in Class III Obesity

Courtney J. Mitchell
1   Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
,
LaMani Adkins 
2   Duke University School of Medicine, Durham, North Carolina
,
Ann Tucker
3   Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi
,
Haywood Brown
4   Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida
,
Anne Siegel
1   Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
,
Sarah Dotter-Katz
1   Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Objective To assess the impact of gestational weight gain >20 pounds (more than Institute of Medicine [IOM] recommendations) on postpartum infectious morbidity in women with class III obesity.

Methods This is a retrospective cohort of term, nonanomalous singleton pregnancies with body mass index ≥40 at a single institution from 2013 to 2017. Pregnancies with multiple gestation, late entry to care, and missing weight gain data are excluded. Primary outcome is a composite of postpartum infection (endometritis, urinary tract, respiratory, and wound infection). Secondary outcomes include components of composite, wound complication, readmission, and blood transfusion. Bivariate statistics compared demographics, pregnancy complications, and delivery characteristics of women exceeding IOM guidelines (GT20) with those who did not (LT20). Regression models were used to estimate adjusted odds of outcomes.

Results Of 374 women, 144 (39%) gained GT20 and 230 (62%) gained LT20. Primiparous, nonsmokers more likely gained GT20 (p < 0.05). No significant difference in other demographics. Among women who gained GT20, 10.4% had postpartum infectious morbidity compared with 3.0% in LT20 (p < 0.01). Wound infection is more common in the GT20 group (7.6 vs. 2%, p = 0.02). After adjustment, women who gained GT20 had threefold higher odds of postpartum infectious morbidity (adjusted odds ratio: 3.17, 95% confidence interval: 1.17, 8.60).

Conclusion Women with class III obesity who gain more than the IOM recommends are at increased risk for postpartum infectious morbidity.

Keywords

morbid obesity - gestational weight gain - endometritis - postpartum wound complication

Presentation Disclosure

This abstract was presented as a poster at the Society of Maternal-Fetal Medicine's 39th Annual Pregnancy, February 11–16, 2019, in Las Vegas, NV.




Publikationsverlauf

Eingereicht: 29. Dezember 2019

Angenommen: 07. März 2020

Artikel online veröffentlicht:
20. August 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Centers for Disease Control. Normal weight, overweight, and obesity among adults aged 20 and over, by selected characteristics: United States, selected years 1988–1994 through 2013–2016. In; 2017. Available at: https://www.cdc.gov/nchs/data/hus/2017/058.pdf . Accessed on September 19, 2019
    PubMed
  • 2 Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015-2016. NCHS Data Brief 2017; (288) 1-8
    PubMedGoogle Scholar
  • 3 American College of Obstetricians and Gynecologists. ACOG committee opinion no. 548: weight gain during pregnancy. Obstet Gynecol 2013; 121 (01) 210-212
    CrossrefPubMedGoogle Scholar
  • 4 El-Chaar D, Finkelstein SA, Tu X. , et al. The impact of increasing obesity class on obstetrical outcomes. J Obstet Gynaecol Can 2013; 35 (03) 224-233
    CrossrefPubMedGoogle Scholar
  • 5 Smid MC, Kearney MS, Stamilio DM. Extreme obesity and postcesarean wound complications in the Maternal-Fetal Medicine Unit Cesarean Registry. Am J Perinatol 2015; 32 (14) 1336-1341
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 6 Leth RA, Uldbjerg N, Nørgaard M, Møller JK, Thomsen RW. Obesity, diabetes, and the risk of infections diagnosed in hospital and post-discharge infections after cesarean section: a prospective cohort study. Acta Obstet Gynecol Scand 2011; 90 (05) 501-509
    CrossrefPubMedGoogle Scholar
  • 7 Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. BJOG 2012; 119 (11) 1324-1333
    CrossrefPubMedGoogle Scholar
  • 8 Gavard JA, Artal R. The association of gestational weight gain with birth weight in obese pregnant women by obesity class and diabetic status: a population-based historical cohort study. Matern Child Health J 2014; 18 (04) 1038-1047
    CrossrefPubMedGoogle Scholar
  • 9 Goldstein RF, Abell SK, Ranasinha S. , et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA 2017; 317 (21) 2207-2225
    CrossrefPubMedGoogle Scholar
  • 10 Ruchat SM, Mottola MF, Skow RJ. , et al. Effectiveness of exercise interventions in the prevention of excessive gestational weight gain and postpartum weight retention: a systematic review and meta-analysis. Br J Sports Med 2018; 52 (21) 1347-1356
    CrossrefPubMedGoogle Scholar
  • 11 Nicodemus Jr NA. Prevention of excessive gestational weight gain and postpartum weight retention. Curr Obes Rep 2018; 7 (02) 105-111
    CrossrefPubMedGoogle Scholar
  • 12 Harper LM, Tita A, Biggio JR. The institute of medicine guidelines for gestational weight gain after a diagnosis of gestational diabetes and pregnancy outcomes. Am J Perinatol 2015; 32 (03) 239-246
    PubMedGoogle Scholar
  • 13 Voerman E, Santos S, Inskip H. , et al; LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group. Association of gestational weight gain with adverse maternal and infant outcomes. JAMA 2019; 321 (17) 1702-1715
    CrossrefPubMedGoogle Scholar
  • 14 Kabiru W, Raynor BD. Obstetric outcomes associated with increase in BMI category during pregnancy. Am J Obstet Gynecol 2004; 191 (03) 928-932
    CrossrefPubMedGoogle Scholar
  • 15 Dotters-Katz SK, Feldman C, Puechl A, Grotegut CA, Heine RP. Risk factors for post-operative wound infection in the setting of chorioamnionitis and cesarean delivery. J Matern Fetal Neonatal Med 2016; 29 (10) 1541-1545
    CrossrefPubMedGoogle Scholar
  • 16 Subramaniam A, Jauk VC, Figueroa D, Biggio JR, Owen J, Tita AT. Risk factors for wound disruption following cesarean delivery. J Matern Fetal Neonatal Med 2014; 27 (12) 1237-1240
    CrossrefPubMedGoogle Scholar
  • 17 Tita AT, Szychowski JM, Boggess K. , et al; C/SOAP Trial Consortium. Adjunctive azithromycin prophylaxis for cesarean delivery. N Engl J Med 2016; 375 (13) 1231-1241
    CrossrefPubMedGoogle Scholar